India Bends Curve on Child Health

Preventing the deaths of millions of children remains one of the country’s greatest challenges.

India is making positive strides in reducing child mortality through new policies and ambitious programs, but preventing the deaths of millions of children remains one of the country’s greatest challenges.

Roughly 1.7 million children under five years old die every year in India, says Unicef, representing more than a fifth of all child deaths worldwide. Most of these deaths are preventable as they stem from complications at birth, pneumonia, diarrhea and malnutrition.

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Earlier this month, Health Minister Ghulam Nabi Azad hailed India’s commitment to work to ensure that no child dies of preventable causes. Extending this latest push on child health, Congress party President Sonia Gandhi launched a program under the Health Ministry that aims to provide comprehensive care to 270 million children every year.

This new program, the Child Health Screening and Early Intervention Services, aims to reduce child mortality and improve the overall quality of life of children. Early detection and treatment would greatly increase the survival chances of children with birth defects, diseases and other health deficiencies.

“If a child dies of a preventable cause, it is a huge tragedy and the nation has to get its act together and intensify efforts to make sure it doesn’t happen,” Anuradha Gupta, a senior official at the Health Ministry, said at a recent conference in Chennai.

The new national screening policy is an encouraging sign of the momentum building around health care programs that target children worldwide. In 2012, 6.9 million children under-five died globally, a depressing statistic but still a sharp improvement from the figure of 7.6 million in 2011.

“India is the most important country in the world when it comes to saving children’s lives and if they can achieve success and we can support it, the world will be well on its way to achieving an extraordinary and historic result of ensuring that every single child around the world lives to see their fifth birthday” said Rajiv Shah, head of USAID.

In 2010 and 2011, India averaged a 7.25% drop in child mortality. However, when data isdisaggregated, it is clear that a child’s chances of survival are hugely dependent on geographic location, caste, class and gender.

This is underlined by the disparity between India’s best and worst performing states. For every 1,000 children born in Madhya Pradesh, 82 are lost to preventable diseases, while Kerala’s rate is more than five times lower at 15 children per 1,000. This postcode lottery for child health is related to budget expenditure, population density and the importance successive governments have placed on health care and public services.

Ms. Gupta says solutions should involve “focusing on equity and the vulnerable populations by mapping the areas where efforts need to be intensified.”

One of the major challenges is that50% of all child mortality in India happens in the first 28 days of life. A prevalent myth is that to save newborns, sophisticated hospitals and intensive care units are needed. But this isn’t the case, experts say.

“Giving a steroid to a mother as she’s going into labor prematurely means the baby will have much more mature lungs and is less likely to die by 40%,” said Mickey Chopra, chief of health at Unicef.

Bikas Das/Associated Press

A child is given the polio vaccine, Kolkata, Jan. 20.

“Wiping the umbilical cord with a disinfectant also reduces deaths by half and by putting the baby onto the mother’s chest and getting them to suckle quickly, that first milk acts an incredibly powerful vaccine against infection,” he added.

Mathuram Santosham, professor of international health and pediatrics at the John Hopkins School of Public Health in the U.S., emphasizes the need for an approach that includes all interventions.

“Breastfeeding, vaccines, hand-washing, zinc supplementation and oral rehydration salts could significantly reduce these preventable deaths. We have made tremendous progress but we all tend to pick our own favorite intervention, whether that is ORS, or zinc or vaccines. It is not an either or, it is very important that every child has access to all the interventions we have available,” he said.

In January, India celebrated reaching two years since its last case of polio and it has been taken off the World Health Organization’s list of endemic countries. That achievement, once thought impossible, should provide a blueprint for the delivery of other health services.

“The lessons learnt and infrastructure put in place, which have led to this massive achievement on polio, must be taken forward to ensure increased routine immunization,” said Helen Evans, deputy chief executive of the GAVI alliance, a public-private partnership based in Geneva that focuses on promoting vaccinations for children.

Routine immunization covering children against tuberculosis, diphtheria, tetanus, whooping cough, polio and measles still lags, with national coverage at only 61%. Without significant progress, children will continue to die of preventable disease.

Challenges remain. India needs political leadership, increased resources and strong partnerships in order to have a comprehensive approach that ensures its children really do get the right to health.

John Butler is a health expert, blogger and writer based in New Delhi, India.

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